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 | Appointment of Representative Form (SSA-1696) | 10/23/2002 |
 | To be completed by attorneys and advocates representing claimant, and signed by claimant. | |
 | Link to Forms on SSA Website | 10/23/2002 |
| | Request for ALJ Hearing (SSA 501), Disability Report - Appeal (SSA 3441), and Medical Authorization (SSA 827) | 10/23/2002 |
| These are the forms for the appeal after the Reconsideration. This appeal is a request for a hearing in front of an Administrative Law Judge (ALJ). The Request for Hearing and Disability Report both need to be filled out, along with Medical Authorization forms for new medical sources listed in the Disability Report. Please note that the Disability Report - Appeal (form SSA-3441-BK) has replaced the old “Claimant’s Statement When Request for Hearing is Filed and the Issue is Disability.” | |
| | Request for Appeals Council Review | 10/23/2002 |
| This is the form required to appeal the decision of the Administrative Law Judge. | |
| | Request for Reconsideration and Disability Report - Appeal | 10/23/2002 |
| These are the forms needed for the first appeal of an SSA decision (e.g., initial denial of benefits). Please note that the Disability Report - Appeal (form SSA-3441-BK) has replaced the old “Reconsideration Disability Report.” In addition to Request for Reconsideration and Disability Report forms, SSA requires Medical Authorization forms (SSA-827) for each of the sources listed in the Reconsideration Disability Report. | |
| | SSA Form for Plan for Achieving Self-Support (SSA-545) | 8/11/2006 |
| PASS | |
| | SSA Request for Waiver of Overpayment Form (SSA-632) | 8/10/2006 |
| Use this form to request a Waiver of an overpayment or a change in the rate at which SSA recoups the overpayment. By requesting a waiver, you admit that there is an overpayment but are claiming that you should not have to pay it back. DO NOT USE THIS FORM TO APPEAL AN OVERPAYMENT THAT YOU THINK IS INCORRECT OR FOR THE WRONG AMOUNT. TO APPEAL OVERPAYMENTS, USE THE REQUEST FOR RECONSIDERATION FORM (see Appeal Forms in this Section). THE REQUEST FOR WAIVER CAN BE FILED AFTER THE APPEAL IS RESOLVED. There is no deadline for requesting a waiver, but there is a 60 deadline for filing a Request for Reconsideration. | |
